Day 74: One Ligament to Another

So at the SIU Carbondale Rugby Tournament I managed to tear another CL, my ulnar collateral ligament (UCL). ACL held up most excellently. According to the team captain I was a tackling machine. Knee felt great through it all, i completely forgot about being only 10 weeks out. Managed to smash the other one into the ground. Currently it's bigger than my right knee.


I don't remember tearing it during the game, but I don't remember tearing it at the social either. Currently my thumb does this awesome trick.


I have an appointment next Monday, but given that I can barely tie my shoes without the joint almost coming out of place (Think of a Mini ACL and the knee) it looks like I'm headed for another 3-6 weeks of a cast/splint and then another 3-6 weeks after that in a soft cast. Good news is I've almost hit my MooP for insurance so this one should be free.


SKIERS THUMB

Day 67: Size doesn't matter.

One of the metrics which I just thought about and wish I had recorded was the circumference of my thy. It's measurable, easily obtainable and it would definitely show a trend towards atrophy, etc.

Even though it's a bit too late to keep record now, I decided to break out the cloth tape measure and see what I was. The doctor was right. My right (surgery) leg was larger.

24.5-24.75 vs 24-24.25. I tried taking the measurement at the same place and apply the same amount of tension. I repeated it a few times until I settled on those measurements.

When I went to Google to determine how I was doing I was suprised at the lack of information. They have chest and bicep sizes for weightlifters, but not leg. I did find this USE AND MISUSE OF THE TAPE-MEASURE AS A MEANS OF ASSESSING MUSCLE STRENGTH AND POWER. Which I believe, I know my right leg isn't up to 100% par with my left. I just wish I measured the entire time so that I'd know what it was doing the whole time. Especially when there was atrophy that people commented on in the early weeks.

While I had the tape measure out curiosity got the best of me... and should I ever need a manzier/bro I'm a 42B.

Day 65: For he to-day that sheds his blood with me shall be my brother

Disclaimer: I am not a doctor, a physical therapist, a trainer or licensed in anyway as a medical professional. More specifically I am not YOUR doctor, physical therapist or trainer. This is just my blog, not advice.

This weekend was Nashbash 27 a massive Rugby tournament in Nashville, TN. I was in Louisville for work and my brother was playing for Purdue and... you can't get away from this sport. And as my dad always said, "You can't play if you don't bring your stuff." I packed the car and went.

Despite some bad Plantar Fasciitis from St Patty's day. And walking around all day at a Truck Show certainly didn't help a single thing.

I watched a few games and made the decision to play. I warmed up by doing some child's pose in yoga. Bending the knees fully, plyometrics, and shuffling. Everything felt solid. For mental assurance I put a wrap on it (you can't wear any hard braces in Rugby).

I went around to a few teams and finally found one that short of subs. Saint Louis Royals showed up with 16. I went in about 10 minutes into the second half and ended up playing around 20-25 minutes. I was put out on the wing where I couldn't do too much. I only touched the ball twice and I don't think made any tackles.

And then we drank and then it rained. And it rained some more and we drank some more. All said the 200 people that were left because the rain was too wet floated 32 kegs in a little over 2 hours. And there was dancing, and slip and slides, and there were zulus and singing. And it was a Rugby Social. Comparable to no sport I've ever played, seen, heard even heard of.

Sunday I got in about the same amount. Except I went in at Flyhalf, many many rookie mistakes from just being out of touch with the position (I haven't played it in over a year and I really don't like it either.) Made a few tackles, made a few runs. Sprinting, turning, running, after about 10 minutes in and being caked with mud I forgot all about my knee. I was still a bit guarded going into tackles and avoiding taking them when possible.

Today I woke up sore, sore everywhere except for my knee. My thy was bruised, my pinkie toe was stepped on, my shoulders ached, my hands were stiff and my quads were tight everything I'd expect from a game of rugby except neither knee bothered me.

I was out of shape. Walking way more than I should have been. I shied away from some tackles I would have taken or made previously, but as I've said before, now it's all mental. Convincing your brain that your knee can handle something after being on crutches for .. well 2 days is hard to do.

Today in the gym with the silence of everyone else lifting I had some extra motivation. On leg press it was:
260x10, 280x10, 300x10, per leg. Now don't go comparing this to yours because the 'gearing' on this one I think is a bit different. But the last set, the set of 300, on my right leg I was taking pauses everyone after 6. The sweat started down my face about 7.

When I stretched between each set (Lat machines are excellent stretching devices. Set the knee pad to the highest setting and hold on to the top (after selecting a weight >= your own)) my quads were the tightest part of my body no longer my knee.

Thanks again St. Louis Royals!

Day 25. Heavy Lifting.

I hit the gym tonight and did my usual aerobic warm-up in front of the TV. Then did some stretches on my knee and found a Yoga mat and went down into child's pose. Rested for a few seconds came back up and went down a few more times.

Since I haven't taken a break from my upper body and it's been since Sunday that I worked on my leg, I decided to do legs today. The last time I did leg press was Sunday, but given that it was a day after rock climbing I think I over did it.

I moved from the incline rack with the loose weights to the other side of the gym to the one with the pin and all the weights already attached. I started out very easy:

Left: 60x10.
Right: 120x10.
Ok. That was too easy.

Left: 80x15
Right: 140x20
Ok. Still too easy. My knee has warmed up very well (I'm working out in sweat pants).

Left: 100x15
Right: 140x30
This can't be right less than a month out and this is too easy.

Left: 120x14.
rest.
Left: 140x20.

I got off of that machine and felt amazing. Grabbed my ankle and did a full flexion - heal of my shoe. Rest of the day I felt great (and still do). Between every set of things I did for the rest of the night I would either go down into Child's pose or just standing hamstring stretch. On the way home I think my left knee may have been aching a bit more due to the weather.

As soon as I got home and showered I got ice on it to keep any swelling down. Unlike last night where I just made contact, tonight I actually got my heel indented my butt. Not quite as far as my left leg, but it's definitely close.

Day 22. Upper Limit

What better way to promote a quick recovery than rock climbing. I had been invited by some co-workers to go rock climbing and thought I'd give it a shot.

We went to the Upper Limits climbing "gym" in Bloomington, IL. After abysmally failing the belay test (it's been at least 10 years since I last belayed) we go to climb. My knee was feeling pretty good. The only thing I couldn't do is some weird bending of the knee. Other than that it was no different than climbing stairs.

The only time I had climbed in the past was in boy scouts and a few of those portable towers. All were designed to be climbed by anyone. This place was not. I made 2 full silo ascents on 5.7 and 5.8s. I climbed an auto belay 5-6 more times. I attempted to go as high as I could on the 5.9 route but gave up (or fell). I much enjoyed the bouldering 'cave' better. Lots of grips everywhere but it still tested your upper and lower body strength and if you fell it was no more than 4'.

My knee was a bit stiff afterwards but nothing more than usual. Felt great to get out and get a workout.

Day 3. PT #1

No pain when I woke up. I can get 5-10 with ease and lifting my leg is quite easy. Walking unassisted feels great also. My extended sleep must have put by body into super repair mode as everything feels relatively great.

I can get 0-45 under my own power. Further if I push it. I no longer have to rely on the crutches trick to stand up.

It's a big day, my first day of PT.

Driving isn't too bad. Occasionally I'll just use my left foot for brake so that I don't have to move my right leg over. It makes for some interesting stops.

First thing I got yelled at for was my walking. Although I'm walking w/o crutches, my form leaves much to be desired. I'm 'clomping' when I walk. Meaning I just keep my leg at 5-10 degrees and drag it along and place it. What I need to be working on is heel-toe, heel-toe.

Official measurement is 85 degrees but I only got one run, no chance to warm up and I didn't get to use a towel. Leg goes completely straight. Dr. Gibbons is not a fan of hyper extension so i shouldn't be pushing it, just getting it straight is the goal.

My leg lifts are ok but not perfect. There is a small lag in between when I lift my leg and when my calf comes off of the ground. Meaning I'm not getting any quad engagement from 0-3 degrees, it's only once the leg is off the ground does my quad kick in and lift the lower leg.

A condition which I've never had before surfaced today when I changed the bandages: blisters. Supposedly what happens is they attach the tape when I'm nice and unswollen. As my knee swells the tape pulls on the surface of the skin and creates blisters. I trimmed the tape back and put some gauze/antiseptic on it.



As I was practicing flexion for the rest of the day I managed to make it pretty far:

Day 2. Progress

The knee was rather stiff when I woke up. I had 4 aspirin and now the pain seems to be down a little. Flexibility is up quite a bit. I'm walking on the leg now with some assistance from the crutches.

While I didn't get any instructions for PT (rather I was just told to come in next Tuesday) I decided to start on my own PT regime loosely following what Dr. Shelbourne had me doing after surgery number 2. While I'm not doing it as often, I am doing it maybe 3-4 times a day. I'm doing towel stretches, leg lifts and quad tightening.

Right now I'm almost up to 90*.


As with almost everything through Week 2. Infinitely better than #1 and slightly worse than #2.
Swelling is under good control:

I did find a good use for my plethora of Cactus cups. They make excellent ice containers. They also last much longer than just cubed ice. I have about 6 in rotation in the freezer so I can get a solid one.



One trick I've found to the CryoCuff to get the longest amount of time out of it: Fill the container with water and attach the Cuff (while it's off your body). Lift up the cooler as high as you can to fill the Cuff completely full. Disconnect and drain out all excess water. Fill the cooler with as much ice as you can and still close the lid. Now drain all the water back into the cooler and put the cuff on. You should have minimal have any 'extra' water now in the container.
(This may not work if you use the Auto Chill)
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Transitioning from laying to standing is the worst. You can feel all the blood rushing to your knee and the pain just goes right up. After about 3-4 minutes when the body adjusts to you standing the pain goes away and everything feels fine.

I'd say that I'm 80% weight bearing. I haven't had any drugs since I woke up, but took more ibuprofens to control swelling.

Day 1. Status Update

My sleep schedule is completely erratic. Due to a number of reasons: I pulled an all nighter the night before the surgery. I'm still a night owl my 'unrestricted' my sleep schedule is 4:00 am - 11 am. Drugs. Lots of Drugs.

I woke up at 3:00 after falling asleep right after my previous day's drugs. I feel completely wide awake. I change out my water and put on some TV. The leg block is still at about 50%. Feeling is returning and I have some movement, but it still is numbed up.

I slept from about 6 am until about 10. Had 4 ibuprofens and 2 Oxycotins at 11 am. The leg block is down to 25%.

I unwrapped the bandages and removed a ton of gauze. Everytime I changed the water out in the CryoCuff I barely felt anything. I figured out why, there was a good 3/4" of insulation between the CryoCuff and my Skin. I removed most of it and put the CryoCuff as close to my skin as possible for maximum cooling.

I have no pain in my quads or in the front of my knee, I'm guessing most probably due to the fact that I didn't have a patellar tendon extracted. Quad tightening is going well. Still not much definition, but I can feel the muscle on the verge of forming.

Walking is about 20% weight bearing I hope to be on the cane by Monday.

5:30pm I had 3 Oxycotins with dinner. They just make me weird sleepy. Just seems to induce narcolepcy. Eyes lose focus of the computer screen and nod off, I've woken up with pages of one letter. However you can tell when they wear off.

Around 10 pm the sides back and inner front of my knee started throbbing. I changed out the CryoCuff water since it had gotten warm and took a few more ibuprofen. (I'm done with the Oxycotins). The block has worn off 100% by now, so I can feel my hand touching my knee, etc. I decided to get some chilling on my knee so I un wrapped it completely and applied a bag of ice to it directly.
-
There's still a bit of bleeding:
but for the most part everything is in place.

Swelling isn't too severe. Remember Swelling = Decreased ROM. I'm on my back 23 hours a day and the CryoCuff is on 24.


I have about 40-45 degrees ROM. No weight bearing (all the weight is going through my crutches).

My 3 ACLs

How they happened:

1. September-ish 2000. Left Knee. Soccer. I was playing sweep when there was a break away chip to the top of the PK box. This is a particularly dirty team, the striker realized that I was out running him to the ball so when we were neck and neck he reached under my arm pit and grabbed my shoulder then threw his weight into me and I went down over my knee. I came back and played a few more games but always ended up going out after torquing. I finally went and saw a doctor after a game of dodge ball in gym when I was running full tilt to the 'line' stopped with my left foot and felt the bones go over each other and went down. My knee got to the size of a grape fruit.
2. July 17, 2004. Right Knee. Rugby game at FWRC Three Rivers Rugby tournament in Fort Wayne. Whored in with a team and was playing outside center. Inside center threw a hospital pass high and behind me. I turned and reached for it at the same time I got tackled across the knees. Stopped playing rugby but continued to run. I knew something wasn't right because I could hyper straighten my leg with ease, leading me to suspect the ACL but I waited until school resumed to see a doctor.
3. December 29, 2007. Right Knee. Snow bowl rugby game in Fort Wayne. Just a bunch of people getting together to play in the winter. I kicked the ball on and was sprinting down field to try and make a tackle/score. The fullback got the ball and we were running straight at each other and he cut left so I cut left and pop. Went down and hobbled off the field, stretched it. Slapped my knee brace on it and finished the game. Even scored a try. Went home that night no swelling at all felt the knee hyper extend with no stop. Immediately knew what I did and sat down and performed a modified Lachman test on myself and put in the call to the local orthopaedic shop as soon as I got back to Peoria.

Doctors & Medical Staff:

1. Dr. Cooper. Fort Wayne Orthopaedics. Patellar tendon graft w/screws.
2. Dr. Shelbourne. Shelbourne Knee Clinic. Patellar tendon graft w/buttons.
3. Dr. Gibbons. Midwest Orthopaedic Center. Allograft patellar tendon w/screws.

Surgery:

1. December 27, 2000
2. November 15, 2004
3. January 25, 2008
   

Recovery:

1. Over night in the hospital and sent home with minimal instructions. PT starting on week 2 for 3 times per week. My leg was in an immobile brace for a while. I remember my first PT visit as being extremely painful getting to 45 degrees. Recovery was slow going. I was excited when I was cleared to run at 5 weeks (instead of the usual 6). I was eventually cleared in time to participate in track my senior year. Although I still had major amounts of atrophy. I lasted on crutches for about 3 days before I was sick of them and their chaffing. I switched to a cane and walked with a major limp (keeping my leg straight and walking with no flexion).
   
2. Over night in the hospital. A week in a CPM machine, swelling was down considerably. I didn't have any sports I was pushing to return to so I took it slow. But for the first few weeks I followed the rehab schedule on Shelbourne's website. 0 PT visits. I only came back twice, 1 week post op and 2 or 3 weeks, to get instructions on how I should do PT on my own.
3. Out patient, I was home that night. I was doing stretches on my own before my first PT visit. This blog should carry you through the rest in greater detail than the other two. I didn't have time to Blogger it all as it happened but I have notes that I'll be entering and post dating.